In collaboration with other research institutes and
public organizations, the Center conducts studies on various aspects of child and
adolescent development, including physical activity and sports, and publishes its findings
in scientific books and articles.
From IXth International Congres of Auxology - year 2000
EARLY PUBERTY AND CENTRAL PRECOCIOUS PUBERTY IN GIRLS: AUXOLOGICAL AND
ENDOCRINE-GYNAECOLOGICAL CRITERIA FOR TREATMENT WITH LHRH ANALOGUES
Ivan Nicoletti (a), Vincenza Bruni (b), Marta Brachi (b), Luca Tafi (a), Silvano Milani
(c)
a) Centro Studi Auxologici - Firenze
b) Clinica Ostetrica e Ginecologica - Università di Firenze
c) Istituto di Statistica Medica e Biometria - Università di Milano.
BACKGROUND. Central precocious puberty and early puberty are defined as the appearance of
Tanner's stage 2 for both pubic hair and breasts before the age of 8 or between the ages
of 8 and 9, respectively, without organic causes and in the absence of pathological
conditions, such as congenital adrenal hyperplasia, hypothyroidism or growth hormone
deficiency. AIM. To evaluate somatic growth in girls who have experienced an early or
idiopathic precocious occurrence of puberty with or without treatment with an LHRH
analogue. PATIENTS AND METHODS. The study includes 41 girls whose puberty began between
5.2 and 8.7 years of age. These girls were divided into two groups: the first (group HR)
included girls considered at high risk of not reaching a final stature falling within the
target range (target range was defined as ±1.28 SD of the mean target height), and the
other group (LR) was made up of girls considered to be at low risk. A girl was assigned to
group HR if she met at least 3 out of 4 auxological criteria and 2
endocrine-gynaecological criteria. .
Auxological criteria: .
(1) skeletal maturity > 80th centile;
(2) height SDS - target height SDS > 1.0;
(3) presence of height growth spurt;
(4) presence of skeletal maturity spurt.
Endocrine-gynaecological criteria:
(1) positive pubertal GnRH (LH peak > 4 x basal value);
(2) signs of development (transitional uterus or microcystic ovary) at ultrasound
examination.
HR girls were given Triptorelin for 12 to 48 months; the treatment was suspended when the
ratio of the increase in skeletal age to the increase in chronological age fell below 0.5.
RESULTS. All girls aged over 13 at the last visit (19 out of 27 HR girls, 10 out of 14 LR)
showed height values within the target range, with the only exception of a HR girl, and
their mean height was by far greater than the mean of untreated historical controls.
COMMENTS. The criteria here adopted seem to be suitable for identifying those girls whose
somatic growth is not affected by the early appearance of puberty (even before the age of
8 years) and, as a consequence, do not need LHRH treatment.
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